Osteoarthritis ranks fifth among all forms of disability worldwide (Cisternas et al. 2016) and it is estimated that 30.8 million adults have osteoarthritis with musculoskeletal disorders representing a global threat to healthy ageing (Murray et al. 2012). Most of the prevalence data on arthritis have been collected in studies conducted in developed countries. However, data from the 2010 global burden of disease study provide some evidence that lower- and middle-income countries (LMICs) such as India and South Africa may have greater arthritis prevalence than high-income countries. Data report that LMICs have 90% of the global burden of disease but only 12% of global health spending (Brennan-Olsen et al. 2017). In South Africa, a meta-analysis carried out on prevalence showed there was 55.1% prevalence of osteoarthritis in urban settings and the incidence ranges between 29.5% and 82.7% in adults over 65 years of age in rural settings. The study was carried out in 2015 and since then there have been no further studies or data available on the topic (Usenbo et al. 2015).

When conservative management of rheumatoid arthritis (RA) and osteoarthritis (OA) fails and the overall quality of life continues to decline for an individual, primary replacement arthroplasty is the surgical treatment of choice to alleviate joint destruction, decrease pain and improve quality of life. Arthroplasty is also recommended as a successful treatment option for late-stage OA (Dunn 2012). Replacement arthroplasties have excellent functional results and total hip replacement has been referred to as the ‘operation of the century’ as more than 95% of patients have been entirely satisfied with the functional results (De l’Escalopier, Anract & Biau 2016). High patient satisfaction is because of the marked decrease in pain and improvements in function with patients being able to participate in activities of daily living that they were previously unable to do within approximately 2 months of the operation (De l’Escalopier et al. 2016).

The current situation in South Africa, which is an LMIC, is that the waiting lists for arthroplasty are extensive with steep costs involved in the management of these patients in public sector hospitals that serve most of the population (Abera Abaerei, Ncayiyana & Levin 2017; Kavalieratos, Nortje & Dunn 2017). This long waiting period can be attributed to discrepancies between available resources, costs of the replacement arthroplasty and the necessary prioritisation of trauma-related procedures leaving very few beds and operating theatres for elective surgeries. This results in patients having to wait for years for arthroplasty procedures, which is a situation unique not only to South Africa (Dunn 2012; Kavalieratos et al. 2017).

In light of the above information, one of the ways in which a physiotherapist can impact the situation of high costs and long waiting times is to implement measures to reduce the length of hospital stay postoperatively (Masaracchio et al. 2017). Length of stay can be impacted by intensive physiotherapy sessions post-operatively and this will directly assist with early discharge creating more beds in the unit for these patients and therefore the waiting times for arthroplasty (Masaracchio et al. 2017). Literature searches around the topic revealed that most studies stipulate bi-daily physiotherapy to assist with early discharge (Masaracchio et al. 2017).

Another measure that can go hand in hand with the above is to adequately prepare, educate and support patients while waiting for the surgery by physical and psychosocial measures with a contextually relevant prehabilitation programme. A quick literature search on the topic of physiotherapy in reducing waiting lists and decreasing length of stay shows that prehabilitation as well as pre-operative education have a significant impact on improving outcomes (Clode, Perry & Wulff 2018; Gill & McBurney 2013; McKay, Prapavessis & Doherty 2012; Saw et al. 2016; Swank et al. 2011; Wallis & Taylor 2011). A meta-analysis of 49 published and unpublished studies shows that the average hospital stay is reduced by 12% and there is a mean reduction of 1.25 days when pre-operative education is incorporated as a part of the package of care (Wallis & Taylor 2011). A study by Crowe and Henderson also report that a prehabilitation programme of exercises and education has a direct impact in reducing the length of stay (Crowe & Henderson 2003).

There is only one South African-based study on prehabilitation carried out by Saw et al. in 2016. The intervention included six physiotherapist-led group-based sessions that included 2 h a week of education, exercise and relaxation at two public hospitals in South Africa. This is one of the few studies carried out by physiotherapists that incorporated patient education as part of prehabilitation and the components of education included education about the condition, self-management of pain and other symptoms, stress management and lifestyle education. Clode et al. (2018) conclude that group education talks about what to expect benefit patients and have a direct bearing on positive outcomes that are also statistically significant.

The types of exercises included were resistance training using resistance bands or weights, flexibility training and functional training such as step training. The studies that described the regime, followed the routine of warm-up exercises followed by resistance training exercises and step training ending with cool-down exercises and static stretching. Most studies indicated that patients come for therapy three times a week, 4–8 weeks prior to the operation (Clode et al. 2018; Gill & McBurney 2013; McKay et al. 2012; Saw et al. 2016; Swank et al. 2011; Wallis & Taylor 2011).

This preliminary review of the literature has in broad terms identified the trends in evidence regarding the content and type of exercises to include in a prehabilitation programme as well as the areas that are traditionally not included as a part of the prehabilitation programme. This provides a justification for conducting a scoping review. The scoping review will allow for a thorough, systematic and in-depth review of the literature to inform the first author on the topic at hand and allow for all relevant literature to be exhaustively analysed and critiqued and described prior to constructing the tenets of the prehabilitation programme that will be contextually relevant to a resource-constrained health system. Therefore, the objective of this scoping review is to identify and map newly reported prehabilitation interventions for patients with arthroplasty (between 1995 and 2020). It is anticipated that the results of our study will provide consensus on the identification and mapping of key aspects of care to include in a prehabilitation exercise programme prior to arthroplasty. Our study will attempt to locate and report on all available studies that have examined prehabilitation in the above population as well as the gaps in this area.

Our protocol was registered within the Open Science Framework platform (registration ID of this study protocol was reported in accordance with the reporting guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA-P) statement and the PRISMA extension for scoping reviews (PRISMA-ScR; Appendix 1).

The methodology will involve conducting a scoping review to map, explore and study the breadth of information available on the topic of prehabilitation and identify gaps in the literature. A scoping review methodology is best suited as it allows for a rapid review of a comprehensive range of literature that includes all levels of evidence which can then be described in a detailed manner. It, however, excludes opinion articles and commentaries. The scoping review strategy as described by Arksey and O’Malley (2005) detailing five stages will be used. The five steps in the following sequence guided the manner in which the scoping review will be conducted: (1) defining the research question, (2) identifying the relevant studies, (3) selecting the main theme for our study, (4) charting and collecting the data and (5) summarising and reporting the results (Arksey & O’Malley 2005).

Our proposed scoping review maps the breadth of knowledge available on the topic of prehabilitation interventions in patients scheduled to undergo joint arthroplasty in terms of exercise prescription principles and other ways to implement pre-operative optimisation and the effects of this on specified outcomes. Our scoping review is the first part of a study that aims to design a prehabilitation programme suitable for a resource-constrained LMIC health care system wherein the demographic and physical characteristics of its health users are unique and dependent on the context. It allows the first author to thoroughly interrogate the available literature and determine the feasibility and applicability of the information available to the context of an LMIC health care system. It also allows for identification and pinpointing of areas that have not been considered thus far, based on the clinical presentation and contextual elements inherent to LMIC thereby allowing the creation of a programme that best suits the needs and challenges of these health care users. It is envisaged that once a suitable programme is developed, it can be used as a template for a basic standard of care that is incorporated as the package of service delivery for arthroplasty. Our scoping review also allows for the identification of future research needs that allow for streamlining of care and perhaps even put in early intervention measures to delay the need for arthroplasty reducing the burden of care. This highlights the potential for cost-cutting and reduced health care expenditure to the stakeholders, healthcare managers and policy makers.

A potential limitation of the scoping review methodology is the fact that only English language studies will be considered.